Rethinking Pain Assessment - page 3

I want to do a little exploration here and get general nursing input from nurses everywhere across all disciplines about assessing pain and in particular non -verbal cues that indicated the patient... Read More

  1. by   gwenith
    Sigh! I will admit to sometimes using the placebo effect. I will give panadol (acetaminophen) and tell them that because it works on different pain receptors it will work where stronger drugs don't and it has a synergistic effect on most medications so that it makes the effect stronger - Okay not ENTIRELY truthful but sounds so good and believable that they do believe. Even if it is not correct and it is just the placebo effect giving the pain relief then - does it really matter so long as they get relief?

    Next question - how many use non-pharmaceutical methods for pain relief and what do you use?
  2. by   canoehead
    I use heat, cold, position change, pillows, sometimes elderly do well with a cup of tea and a cracker. But with severe pain I like to give the quick fix- IV drugs- and then go for the TLC afterwards.
  3. by   Irwin0111
    We are all connected with one another in anyway for whatever that is. I have my full belief that even for the things we feel I mean everything we feel inside out the spirit in us will always make its way to be obvious in all attempt even in the slightest form of emotion. Because,it somehow reveals the truth.be it on the good side or the bad and as the spirit in us dwells in the good, on how one inevitably make show the way he feels if say he is feeling good/happy is lettiing the infectious nature of that emotion to reach out to others in its will to edify or just share others the benefit of that particular emotion. that would mean exactly the same to those that are bad. but in attempt to caught others aware in such spirit desire for others help that in turn makes one ackowledge the basic fact about life that we are all connected in such a way.
    letting yourself understand the nature of us. Will help us how we deal about everything.As i say,you will always tell it right if one is really feeling pain even in the most silent of moments.

    Am I getting it right? i dont know? Studies will add better into that .

    ywee
  4. by   purplemania
    Brady in kids is always a red flag. Their normal tendency is to be tachy. If they WERE tachy, then went brady on me I would be very nervous. Of course, at 60 beats/min we start CPR if a small child. Maybe the body is overcompensating. This is why rest (with or without sleep) is so impt. to people in pain. Conversation is a stimulant to a degree. Visitors need to be educated to this.
  5. by   luv-my-dal
    Great thread.....
    I believe that, yes, we must believe what the patient tells us. Who are we to say how each individual should/will react with pain? We each feel pain differently and with individual reaction to each episode....
    Could you imagine how much more stress that would add to us if we had to "judge" everyone on what we thought their pain was and if it was "adequate" to the situation?
    Anyway....I obviously do not have the answer you are looking for as I have recited probably what others have thought also....
    I am going to thoroughly read through the posts and see what others have to say....
    I really like these "thought provoking" beyond-the- text-book threads! Thanks Gwenith
  6. by   CCU NRS
    Originally posted by gwenith
    I want to do a little exploration here and get general nursing input from nurses everywhere across all disciplines about assessing pain and in particular non -verbal cues that indicated the patient may have pain.

    I don't want this to degenerate into an argument about "If the patient says they have pain we must treat it". That is a "given".

    What I am after is the non-verbals such sa posture, pallor, attitude etc of the person in pain that would tell you they have pain.

    Are there patterns of pain response particular to chest pain or abdominal pain or male vs female?

    I am also looking for indications that might lead you to think that the person is either overreporting their pain or is faking entirely. Asking this part of the question is not a validation for withholding pain medications but a way to work out how and why we are getting a different non-verbal message to the verbal one.

    I am not looking for textbook answers here what I am exploring is data that may not or will not be in a text book.

    If you like think of this as phenomenological research. Everyone's opinion and experiences are valid and worthy. From your responses I will try to summarise and recap and see if we can take the research up to the next level.
    I do not have time to read the entire thread but am very intrigued by you research and wish to participate.


    I assess a Pt on entering the room by looking at and speaking directly to them. My first assessment of pain in their actions ie swiftness of movement, grimace, facial droop, favoring or guarding, sounuds that are made with movement from creak crack groan to rub wheeze whistle. I speak clearly and assess hearing by changing pitch and volume as seems appropriate. I then listen to Heart, lungs, bowels abdomen and while finishing ask do you have any pain or probelms right now? I listen to thier description of any pain they wish to report and ask question such does bother you all the time or just when you are doing certain things? I ask what brings it on or starts it? I assess any area appropriately, ie abd. I will press and assess if pain is rebound or tenderness etc. I will also watch for facial expressions and othr subjective sign during this assessment, writhing, pulling away, grimace etc. I will then (except with "life Threatening situations") assess VS I look at my monitor last unless there is something coronary obviously going on because with generallized pain I am not a GIANT fan of VS being a big indication. Yes some will have big changes and all will likely have some changes but with chornic pain I feel that people that live in large amounts of pain daily the system begins to regulate if that system is capable, if not then the Pt will be presenting with a life threatening situation R/T long term chronic pain that has broken down the healthy system. This is my usual assessment process hop it helps.
  7. by   CCU NRS
    Originally posted by gwenith
    Sigh! I will admit to sometimes using the placebo effect. I will give panadol (acetaminophen) and tell them that because it works on different pain receptors it will work where stronger drugs don't and it has a synergistic effect on most medications so that it makes the effect stronger - Okay not ENTIRELY truthful but sounds so good and believable that they do believe. Even if it is not correct and it is just the placebo effect giving the pain relief then - does it really matter so long as they get relief?

    Next question - how many use non-pharmaceutical methods for pain relief and what do you use?
    I admit I had a brother that was a quadriplegic and he was beleived to be a drug seeker. I tried my own little experiment to satisfy my self. He had continual abd pain. I brought some Iron pills to him one day and told I had something new I wanted him to try for his pain. I told him a Docotr had written me a trial script for it and it was a brand new medicine that was a snythetic morphine derivitive. I called it FeS04. I was saddened by his response he became pain free, I gave it to him a few times and tried to be sure it was working. He told me everytime that it really helped. I finally told him that it was just iron and that I thought maybe he wanted it to work well and it did. he was furious at me and I tried to tell him this was a good thing he could finally beat his problem he was just sour at me and never really had the epiphinany I had hoped he would. He was my brother so I loved him even more.
  8. by   renerian
    I know when I have had severe pain I rock. I sit and rock back and forth.

    renerian
  9. by   gwenith
    Thank-you for reawakening this thread - I will get back to it after christmas and look at some of the replies - summarise and see what we can do about consolidating some of the information.
  10. by   BarbPick
    personally, in the days when endometriosis was a severe problem, my usual normal blood pressure would go sky high when I was in pain.

    When I was a student Nurse a drug called APC's (asprin phenacitin and caffeine) were standard medication. The FDA took phenacitin off the market due to renal problems. They would knock out a headache in 10 minutes. They always came in pink tablets or green. My instructor taught us to us a little spin to it when giving them, telling the patient they were strong pain pills and putting up the side rails for safety and telling them to call the nurse if they needed to get up. It worked like a charm, and the patient usually went to sleep.
  11. by   Nurse 2
    It seems we all have differing attitudes that effect how we act and react to pain.
    I am an RN with many years experence, and am currently in the process of doing a paper for my MS in Biomedical Ethics. This paper will be on pain, not because I really wanted to do a paper on it, but at the strong urging from my thesis advisors. (Now I am actually interested in it)!
    Anyway, my question is this: Aside from using the standard pain scales, do you think you rate some pain higher than other types of pain. If so, how do you treat them. In other words, do you obtain pain meds for a patient with chest pain, or an acute injury more quickly than you do with say.. a chronic pain pt, or chronic complainer?
    Does anyone think how you deal with your own pain, or family members experencing pain directly or indirectly effect how you treat pain in you patients- be honest..
    Thanks
  12. by   Rapheal
    For pain that is more acute than chronic, I have observed the following in older teens and not yet elderly adults:

    Increasing irritability and short answers to questions when pain increases

    Frequent sighing

    The need to shut out sensory stimulation- they want the room dark, the door closed, the TV off

    Some patients will threaten to leave AMA if "something" is not done to help them

    decrease in appetite, little interest in visitors


    For elderly patients:

    Restlessness, anxiety,

    poor appetite, lethargy

    they will tell you they feel nervous



    Hope these observations help Gwenith.
  13. by   Disablednurse
    Pain is a strange thing. I too am a nurse of 26 years, who has been disabled for two years because of failed back syndrome. I have herniated disks from L1 down either to the left or the right. I have had a spinal fusion. I am in pain 24/7. I am on MS Contin 75mg every 8 hours as well as oxycodone every six hours for breakthrough pain. The pain is dulled but never gone. I laugh, enjoy life as much as I can. People tell me if I get up more then I would probably feel better. Unfortunately, I found out that it does not work that way. People tell me that I look great, so therefore I must be pain free. I just see no need to go around with a long face crying all the time. I had two surgeries on my back and it got worse after each time. Now I will just be satisfied to try to live the best I can in constant pain. I am also seeing a pain management doctor and he said that there was nothing else that he could.

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